Health Canada has announced new guidelines around the prescribing and dispensing of Mifegymiso, stripping away several barriers women faced to access the so-called “abortion pill.”

The changes include allowing the medication to be directly dispensed to patients by a pharmacist, which they could not do before. The new regulations also allow Mifegymiso to be prescribed up to nine weeks or 63 days into a pregnancy. The previous limit was seven weeks or 49 days.

The new Health Canada guidelines will reinforce guidelines already released by professional bodies such as the Society of Obstetricians and Gynaecologists of Canada (SOGC).

The SOGC had previously published guidelines naming 10 weeks as the time limit for a medical abortion. “This is much more in line with what we issued last year,” said Dr. Édith Guilbert, one of the authors of the SOGC guidelines. “It’s a major step.”

Consistent messages will be helpful both to patients and medical professionals, said Ariane Wylie, the medical abortion access co-ordinator at Planned Parenthood Ottawa.

“The closer to the SOGC guidelines, the more comfortable people will feel in prescribing. It eliminates a lot of barriers,” she said.

The changes to the time limitations give patients two more weeks to access a medical abortion. “This makes a big difference,” said Wylie.”People don’t even realize they are pregnant until five weeks. It’s a big step forward.”

Mifegymiso, a non-surgical option for early-term “medical” abortion, is comprised of two drugs, mifepristone and misoprostol, which are taken in sequence to prompt an effect like an early miscarriage. Mifepristone blocks the effects of the hormone progesterone, causing the lining of the uterus to break down. Two days later, the patient takes misoprostol, which causes uterine contractions.

A lot of different players have to come together in a tight time frame for a woman to access a medical abortion. The first step is an ultrasound to determine the stage of pregnancy. The next is a doctor to prescribe Mifegymiso. The third is a pharmacist to dispense it.

Although the cost of Mifegymiso is covered in Ontario, there are currently only five pharmacies that dispense it in the Ottawa area, said Catherine Macnab, executive director of Planned Parenthood Ottawa. The agency typically gets about five calls a days with questions about Mifegymiso, including where callers can get a prescription filled.

The Canadian Pharmacists Association is calling on provincial governments to provide all women with equitable access through universal coverage across Canada. Some provinces, including Ontario, cover the cost. Manitoba announced in July it was covering the cost, but patients had to go to approved sites, sparking criticism that women from northern and rural communities were being treated inequitably.

Phil Emberley, an Ottawa pharmacist who is the association’s director of practice, advancement and research, predicts there will be more collaboration between physicians and pharmacists, and more pharmacists dispensing the medication directly to women.

He also applauded extending the time limit to nine weeks of gestation. That puts Canada more in line with other jurisdictions and gives women seeking a medical abortion more time, so they don’t have to seek a more invasive surgical abortion, he said.

As of September, about 800 health-care professionals had completed a course to prescribe Mifegymiso, but only two clinics in Ottawa were prescribing it. It shows a disconnect between the intent to prescribe it and actually prescribing, said Macnab.

The new Health Canada guidelines remove the requirement for medical professionals to take an education program before prescribing Mifegymiso. Health Canada also announced it has removed the requirement for written patient consent to take the medication, and health professionals no longer have to be registered with drug distributor Celopharma to prescribe or dispense Mifegymiso.

It’s easier for a doctor to prescribe an opioid than the abortion pill, said Wylie.

“It shouldn’t be necessary for a woman to seek a specialist to access a medical abortion.”

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